Rethinking Insurance Coverage of “Experimental” Applied Behavioral Analysis Therapy and Its Usefulness in Combating Autism Spectrum Disorder

2013 ◽  
Vol 34 (2) ◽  
pp. 215-233 ◽  
Author(s):  
Kendra Hansel
Author(s):  
Ilker Ozsahin ◽  
Mubarak T Mustapha ◽  
Safa Albarwary ◽  
Burcin Sanlidag ◽  
Dilber Uzun Ozsahin ◽  
...  

Aim: Autism spectrum disorder is a class of neurological disorders that affect the development of brain functions. This study aims to evaluate, compare and rank the therapy techniques used in the management of autism spectrum disorder using multicriteria decision-making approaches. Materials & methods: Fuzzy PROMETHEE and fuzzy TOPSIS approaches were used. Fuzzy PROMETHEE utilizes a pair-wise comparison of alternatives under the fuzzy environment while fuzzy TOPSIS utilizes geometric distance from the positive ideal solution under the fuzzy environment for the evaluation of the effectiveness of the alternatives.The techniques selected for evaluation are applied behavioral analysis, cognitive behavioral therapy, speech therapy and pharmacological therapy such as Risperidone and Aripiprazole. Criteria used in this study include efficacy, cost and side effects, and their weights are assigned based on specific patient conditions. Results: The results indicate that applied behavioral analysis, cognitive behavioral therapy and speech therapy are the most preferred techniques, followed by Aripiprazole and Risperidone. Conclusion: More criteria could be considered and the weights could be assigned according to the patient profile.


2011 ◽  
Vol 26 (S2) ◽  
pp. 355-355
Author(s):  
A. Soltanifar ◽  
M. Hojati ◽  
A. Mashhadi ◽  
P. Reebye

IntroductionSeveral approaches have been presented for treatment of children with ASD. The aim of the present study was to compare the efficacy of Holistic Multidimensional Treatment Model (HMTM) with Applied Behavioral Analysis (ABA) in the improvement of clinical symptoms of children with ASD.MethodThe present study was an experimental pre and post test research. The statistical population included the 3 to 8 year old children with ASD who were referred to the child psychiatry clinics in two academic Hospitals- Mashhad,Iran. The sample included 20 children who were selected with convenience sampling and randomly divided to 2 groups of ABA (8 boys and 2 girls) and HMTM (7 boys and 3 girls).The diagnosis was made by a child psychiatrist based on DSM-IV-TR criteria and using Autism Diagnostic Interview-Revised (ADIR) and Autism Diagnostic Observation Schedule (ADOS).Then the children were referred to Noore Hedayat center for the treatment. Childhood Autism Rating Scale (CARS), Bender Gestalt Test, Draw-A-Man Test Good enough, Raven's Colored Progressive Matrices Test for children, Vineland Social Maturity Scale (VSMS) and performance charts of children based on their videotaped behaviors. Data analysis was done using ANCOVA test.ResultsFindings showed that in spite of more efficacy of HMTM compared to ABA, the differences of standard tests except Bender Gestalt Test and performance charts did not reach to the significant level(p > 0.05).ConclusionIn conclusion, HMTM at least had the equal efficacy to ABA in the treatment of children with Autism Spectrum Disorder. Further researches are needed to compare the efficacy of these 2 methods.


2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e37-e37
Author(s):  
Fanny Lacelle-Webster ◽  
Rinita Mazumder ◽  
Sandy Hodgetts ◽  
Lonnie Zwaigenbaum

Abstract BACKGROUND Autism Spectrum Disorder (ASD) affects more than 1% of the population. In 2009, the Canadian College of Medical geneticists recommended genome-wide microarray analysis as a first-line investigation for children with a diagnosis of ASD. OBJECTIVES The purpose of this study is to explore experiences and preferences of parents with children with ASD regarding information about genetic testing. DESIGN/METHODS In this mixed method study, parents of children with a diagnosis of ASD (age 2 to 17 years) were recruited through advertisements on websites and Facebook pages of community partners. The first step was an on-line survey housed on a secure web-based platform. In addition to demographic data, the survey collected information about the experiences and informational preferences of the parents about genetic testing. A subset of participants, based on expressed interest, participated in an in-person semi-structured interview. All interviews were recorded, transcribed and coded for major themes and sub-themes. RESULTS A total of 31 participants responded to the survey and 5 interviews were completed. Their children had received their diagnosis between 2004 and 2017. The online survey revealed that 69% of participants were aware of genetic testing and 38% had genetic testing completed. Overall, 94% wanted to have more information about genetic testing; notably, only 25% had heard about microarray. Receiving information about genetic testing was preferred in a follow up appointment by 56% of participants, but 28% preferred to receive information on the date of ASD diagnosis. Most participants (81%) identified their community paediatrician as the preferred physician to discuss genetic testing with them. Almost all interview participants were concerned that the information from genetic testing could be detrimental to their child, noting, for example, potential difficulties obtaining insurance coverage. Some shared their concerns regarding their paediatrician’s knowledge about genetic testing and ASD; in fact, two families decided to change to a new paediatrician to fulfill their needs of information about ASD and genetic testing. CONCLUSION This study showed that parents of children with ASD are globally interested to learn more about genetic testing, with their paediatrician being their preferred resource. For that reason, it appears important that paediatricians be aware of the recommended investigations for children with ASD and have a good understanding of the implications of genetic testing.


2021 ◽  
Vol 22 (3) ◽  
pp. 260-277
Author(s):  
Mahta Alsadat Aarabi ◽  
◽  
Kianoosh Abdi ◽  
Mohammad Saeed Khanjani ◽  
◽  
...  

Objective: One of the essential needs of patients with Autism Spectrum Disorder (ASD) and their families is the rehabilitation services to improve patients’ performance in social interactions and communication. However, access and use of these services pose many challenges for patients with ASD and service providers. This study systematically reviews the challenges of access and use of rehabilitation services for patients with ASD. Materials & Methods: This is a systematic review of the articles published from 2010 to 2020 in Persian and English on the challenges of accessing and using rehabilitation services for patients with ASD. The search was conducted in online databases of Google Scholar, PubMed, Scopus, ProQuest, Science Direct, SID, and MagIran using the keywords of “challenge”, “utilization”, “accessibility”, “rehabilitation”, “healthcare”, and “autism”. The initial search yielded 142 articles. After checking their titles, 102 articles were removed because they were irrelevant or duplicates, and 40 remained. Finally, 14 studies were selected for the review after checking their abstracts and considering the inclusion criteria. Results: In general, due to the nature of ASD, patients and their families have many challenges in accessing and using rehabilitation services. Their essential challenges were high costs of services, insufficient insurance coverage, lack of parental involvement in healthcare, scarcity of some essential services, lack of access to specialists in ASD, no government support, long waiting times, no transportation, lack of information of parents about how to access the required services, heterogeneity of services provided in different centers, inefficiency in diagnosing and screening people with ASD, lack of rehabilitation monitoring, incoordination between autism centers, challenges related to the structure and maintenance of services, and low manpower of service providers. Conclusion: People with ASD face several challenges in accessing and using rehabilitation services. Our study results can be helpful for the effective use of rehabilitation services by these patients, improving their living conditions, and ultimately their quality of life. Recognizing these challenges can pave the way for policymakers, intervention managers, and planners to take more effective steps for providing rehabilitation services to patients with ASD as their human rights. The authorities should pay more attention to existing resources, adopt and implement the necessary programs, solve the identified challenges, and reform the administrative structures of autism rehabilitation.


2020 ◽  
Vol 29 (4) ◽  
pp. 1783-1797
Author(s):  
Kelly L. Coburn ◽  
Diane L. Williams

Purpose Neurodevelopmental processes that begin during gestation and continue throughout childhood typically support language development. Understanding these processes can help us to understand the disruptions to language that occur in neurodevelopmental conditions, such as autism spectrum disorder (ASD). Method For this tutorial, we conducted a focused literature review on typical postnatal brain development and structural and functional magnetic resonance imaging, diffusion tensor imaging, magnetoencephalography, and electroencephalography studies of the neurodevelopmental differences that occur in ASD. We then integrated this knowledge with the literature on evidence-based speech-language intervention practices for autistic children. Results In ASD, structural differences include altered patterns of cortical growth and myelination. Functional differences occur at all brain levels, from lateralization of cortical functions to the rhythmic activations of single neurons. Neuronal oscillations, in particular, could help explain disrupted language development by elucidating the timing differences that contribute to altered functional connectivity, complex information processing, and speech parsing. Findings related to implicit statistical learning, explicit task learning, multisensory integration, and reinforcement in ASD are also discussed. Conclusions Consideration of the neural differences in autistic children provides additional scientific support for current recommended language intervention practices. Recommendations consistent with these neurological findings include the use of short, simple utterances; repetition of syntactic structures using varied vocabulary; pause time; visual supports; and individualized sensory modifications.


2020 ◽  
Vol 29 (2) ◽  
pp. 890-902
Author(s):  
Lynn Kern Koegel ◽  
Katherine M. Bryan ◽  
Pumpki Lei Su ◽  
Mohini Vaidya ◽  
Stephen Camarata

Purpose The purpose of this systematic review was to identify parent education procedures implemented in intervention studies focused on expressive verbal communication for nonverbal (NV) or minimally verbal (MV) children with autism spectrum disorder (ASD). Parent education has been shown to be an essential component in the habilitation of individuals with ASD. Parents of individuals with ASD who are NV or MV may particularly benefit from parent education in order to provide opportunities for communication and to support their children across the life span. Method ProQuest databases were searched between the years of 1960 and 2018 to identify articles that targeted verbal communication in MV and NV individuals with ASD. A total of 1,231 were evaluated to assess whether parent education was implemented. We found 36 studies that included a parent education component. These were reviewed with regard to (a) the number of participants and participants' ages, (b) the parent education program provided, (c) the format of the parent education, (d) the duration of the parent education, (e) the measurement of parent education, and (f) the parent fidelity of implementation scores. Results The results of this analysis showed that very few studies have included a parent education component, descriptions of the parent education programs are unclear in most studies, and few studies have scored the parents' implementation of the intervention. Conclusions Currently, there is great variability in parent education programs in regard to participant age, hours provided, fidelity of implementation, format of parent education, and type of treatment used. Suggestions are made to provide both a more comprehensive description and consistent measurement of parent education programs.


2020 ◽  
Vol 29 (1) ◽  
pp. 327-334 ◽  
Author(s):  
Allison Gladfelter ◽  
Cassidy VanZuiden

Purpose Although repetitive speech is a hallmark characteristic of autism spectrum disorder (ASD), the contributing factors that influence repetitive speech use remain unknown. The purpose of this exploratory study was to determine if the language context impacts the amount and type of repetitive speech produced by children with ASD. Method As part of a broader word-learning study, 11 school-age children with ASD participated in two different language contexts: storytelling and play. Previously collected language samples were transcribed and coded for four types of repetitive speech: immediate echolalia, delayed echolalia, verbal stereotypy, and vocal stereotypy. The rates and proportions of repetitive speech were compared across the two language contexts using Wilcoxon signed-ranks tests. Individual characteristics were further explored using Spearman correlations. Results The children produced lower rates of repetitive speech during the storytelling context than the play-based context. Only immediate echolalia differed between the two contexts based on rate and approached significance based on proportion, with more immediate echolalia produced in the play-based context than in the storytelling context. There were no significant correlations between repetitive speech and measures of social responsiveness, expressive or receptive vocabulary, or nonverbal intelligence. Conclusions The children with ASD produced less immediate echolalia in the storytelling context than in the play-based context. Immediate echolalia use was not related to social skills, vocabulary, or nonverbal IQ scores. These findings offer valuable insights into better understanding repetitive speech use in children with ASD.


2020 ◽  
Vol 29 (2) ◽  
pp. 586-596 ◽  
Author(s):  
Kaitlyn A. Clarke ◽  
Diane L. Williams

Purpose The aim of this research study was to examine common practices of speech-language pathologists (SLPs) who work with children with autism spectrum disorder (ASD) with respect to whether or not SLPs consider processing differences in ASD or the effects of input during their instruction. Method Following a qualitative research method, how SLPs instruct and present augmentative and alternative communication systems to individuals with ASD, their rationale for method selection, and their perception of the efficacy of selected interventions were probed. Semistructured interviews were conducted as part of an in-depth case report with content analysis. Results Based on completed interviews, 4 primary themes were identified: (a) instructional method , (b) input provided , (c) decision-making process , and (d) perceived efficacy of treatment . Additionally, one secondary theme, training and education received , was identified . Conclusions Clinicians reported making decisions based on the needs of the child; however, they also reported making decisions based on the diagnostic category that characterized the child (i.e., ASD). The use of modeling when teaching augmentative and alternative communication to individuals with ASD emerged as a theme, but variations in the method of modeling were noted. SLPs did not report regularly considering processing differences in ASD, nor did they consider the effects of input during instruction.


2020 ◽  
Vol 5 (1) ◽  
pp. 314-325
Author(s):  
Kimberly F. Frazier ◽  
Jessica Collier ◽  
Rachel Glade

Background The aim of this study was to determine the clinical efficacy of combining self-management strategies and a social thinking approach to address the social performance and executive function of an adolescent female with autism spectrum disorder. Method This research examined the effects of a social knowledge training program, “Think Social,” as well as strategies to improve higher order cognitive abilities. Results and Conclusion Although quantitative improvement was not found, several qualitative gains in behavior were noted for the participants of this study, suggesting a benefit from using structured environmental cues of self-management strategies, as well as improved social understanding through social cognitive training.


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